Healthcare Provider Details

I. General information

NPI: 1043121577
Provider Name (Legal Business Name): DANIEL VILLA SALAZAR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SOQUEL AVE
SANTA CRUZ CA
95062-1402
US

IV. Provider business mailing address

1900 HIGHWAY 1 SPC 24
MOSS LANDING CA
95039-9626
US

V. Phone/Fax

Practice location:
  • Phone: 831-600-2801
  • Fax:
Mailing address:
  • Phone: 831-234-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number758206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: